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2381. Private Sector Efforts in Value-Based Purchasing and Quality Improvement | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/quality-measures/21st-century/private-sector.html
      June 01, 2018 - The Challenge and Potential for Assuring Quality Health Care for the 21st Century Private Sector Efforts in Value-Based Purchasing and Quality Improvement Previous Page   Table of Contents The Challenge and Potential for Assuring Quality Health Care for the 21st Century From Quality Measures to Qu…

2382. 021-Ss-Mrsa-Surveillance-Fg (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/021-ss-mrsa-surveillance-fg.docx
      April 01, 2025 - AHRQ Safety Program for MRSA Prevention: Targeting SSI MRSA Surveillance Surgical Services For: Cardiac, Hip and Knee Joint Replacement, and Spinal Fusion Surgeries Slide Title and Commentary Slide Number and Slide MRSA Surveillance SAY: This presentation will include information on MRSA surveillance, which will …

2383. Patient Safety Culture and Medical Liability—Recommendations for Measurement, Analysis, and Interpretation: A Commentary | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/reports/liability/waever.html
      August 01, 2017 - Advances in Patient Safety and Medical Liability Patient Safety Culture and Medical Liability—Recommendations for Measurement, Analysis, and Interpretation: A Commentary Previous Page Next Page Table of Contents Advances in Patient Safety and Medical Liability Preface Acknowledgments Prologue …

2384. 26,000 Close Call Reports: Lessons from the University of Texas Close Call Reporting System (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Simmons_66.pdf
      April 03, 2008 - that explain why employees may not report errors: (1) fear, (2) disagreement over whether an error occurred … Also, because historically reports were submitted only when an actual error had occurred, a “change

2385. Improving Patient Safety in Long-Term Care Facilities, Module 3 (pdf file)
      www.ahrq.gov/sites/default/files/publications/files/ltcmodule3.pdf
      June 01, 2012 - Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Knowing When a Fall Has Occurred … Knowing When a Fall Has Occurred A person can end up on the ground for many reasons.

2386. Developing a Community-Wide Electronic Shared Medication List (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Stock_113.pdf
      June 15, 2005 - the electronic tool by patients and clinicians; measure the degree to which medication discrepancies occurred … Electronic Medication List The clinic medication process-mapping phase and technical development of tools occurred … In summary, leadership observed that an organizational transformation occurred from fear of including … Health Care Clinics Two major improvements occurred in the clinic setting: (1) the clinic medication

2387. Introducing the AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture: Webcast Transcript (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/asc/ascwebinar/ascwebcast0715_transcript.pdf
      September 01, 2015 - Introducing the AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture: Webcast Transcript 1 Introducing the AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture July 15, 2015 – Webcast Transcript Speakers Jim Battles, PhD, AHRQ Center for Quality Improvement and Patient Safety, Rockville, …

2388. Implementing the New CAHPS Protocol for Obtaining Patient Comments About Their Care (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/implementing-new-protocol-transcript.pdf
      October 01, 2018 - Implementing the New CAHPS Protocol for Obtaining Patient Comments About Their Care Implementing the New CAHPS Protocol for Obtaining Patient Comments About Their Care October 2018  Webcast Speakers Caren Ginsberg, PhD, Director, CAHPS Division, Center for Quality Improvement and Patient Safety, Agency for H…

2389. Measure 1, Section 2, Attachment 1 (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-88-measure-1-section-2-attachment-1.pdf
      February 01, 2012 - Measure 1, Section 2, Attachment 1 Attention Deficit Hyperactivity Disorder Performance Measurement Set Supported by AHRQ/CHIPRA-PQMP Proposed by the ADHD Expert Work Group (listed in Appendix A) In collaboration with the Pediatric Measurement Center of Excellence (PM…

2390. Attention Deficit Hyperactivity Disorder Performance Measurement Set (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-89-adhd-behavior-section-2-attach-1.pdf
      February 01, 2012 - Attention Deficit Hyperactivity Disorder Performance Measurement Set Attention Deficit Hyperactivity Disorder Performance Measurement Set Supported by AHRQ/CHIPRA-PQMP Proposed by the ADHD Expert Work Group (listed in Appendix A) In collaboration with the Pediatric Meas…

2391. Final Progress Report: Drug-Drug Interaction Clinical Decision Support Conference Series (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/malone-report.pdf
      January 01, 2024 - Final Progress Report: Drug-Drug Interaction Clinical Decision Support Conference Series Drug-Drug Interaction Clinical Decision Support Conference Series Investigators: Daniel C. Malone, RPh, PhD, Principal Investigator Mary L. Brown, PhD, Co-Investigator Lisa E. Hines, PharmD, Co-Investigator Amy Grizzle, Pha…

2392. Final report: To Quantify the Impact of the Existing vs. Enhanced Work Configuration of Radiation Therapy Technicians on Workload, Situation Awareness, and Performance during Pretreatment QA Tasks (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/mosaly-report.pdf
      January 01, 2024 - Final report: To Quantify the Impact of the Existing vs. Enhanced Work Configuration of Radiation Therapy Technicians on Workload, Situation Awareness, and Performance during Pretreatment QA Tasks To Quantify the Impact of the Existing vs. Enhanced Work Configuration of Radiation Therapy Technicians on Workload, Sit…

2393. Final Progress Report: Mentored Implementation of I-PASS for Better Handoffs and Safer Care (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/landrigan-report.pdf
      January 01, 2024 - Final Progress Report: Mentored Implementation of I-PASS for Better Handoffs and Safer Care AHRQ Grant Final Progress Report  Landrigan, Christopher P. Grant Award Number: 1R18HS023291‐01  Title Page Title of Project: Mentored Implementation of I-PASS for Better Handoffs and Safer Care Principal Investigator and…

2394. Module 1: Using the Comprehensive Long-Term Care Safety Modules: Applying Safety Principles: Facilitator Notes | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module1/mod1-facguide.html
      March 01, 2017 - When reckless behavior has occurred, it must be met with remedial or punitive action to decrease or eliminate

2395. Facilitator-Notes (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/long-term-modules/module1/facilitator-notes.docx
      March 01, 2017 - When reckless behavior has occurred, it must be met with remedial or punitive action to decrease or eliminate

2396. On-Time Pressure Ulcer Healing: Facilitator Training Instructor's Guide | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruhealing/guide.html
      December 01, 2017 - high risk or had a recent change in risk, would we do things differently to intervene before the event occurred

2397. Department of Veterans Affairs Emergency Airway Management Initiative (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Stalhandske_71.pdf
      February 23, 2008 - These claims included some cases that occurred within the operating room. … Our database was unable to differentiate those that occurred due only to emergency airway management.b

2398. PowerPoint Presentation
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/esrd/creating-safety-culture/cultureofsafety_hemodialysis.pptx
      September 03, 2014 - In determining what defect occurred, teams reconstruct the timeline of the event by placing themselves … well as offering help to their peers.     42 Feedback Timely—give soon after the target behavior has occurred … promote a supportive climate, feedback must be:   Timely, and given soon after the target behavior has occurred … Try to view the world as they did when the event occurred.   Why did it happen? Step 1.

2399. PowerPoint Presentation
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/esrd/using-checklists/checklistandauditslides.pptx
      September 03, 2014 - Facility A Checklists and monthly process audits were instituted Problem identified: Breaks in process occurred … In determining the defect that occurred, teams reconstruct the timeline of the event by placing themselves … Try to view the world as they did when the event occurred. Why did it happen? Step 1.

2400. Selected Best Practices and Suggestions for Improvement (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4k_combo_psi14-dehiscence-bestpractices.pdf
      May 20, 2016 - Selected Best Practices and Suggestions for Improvement Toolkit for Using the AHRQ Quality Indicators How To Improve Hospital Quality and Safety 1 Tool D.4k Selected Best Practices and Suggestions for Improvement PSI 14: Postoperative Wound Dehiscence Why Focus on Postoperative Wound Dehiscence? • Postop…